S. 3560 — Closing the Contraception Coverage Gap Act

This section establishes Medicare coverage of contraceptive items and services (i.e., physician- or practitioner-furnished contraceptives aligned with January 12, 2022, Public Health Service Act guidance, ancillary services such as examinations and counseling, and follow-up care, regardless of whether furnished for contraceptive purposes) with no cost-sharing under Parts B, C, and D, effective January 1, 2027. Under Part B, the section (1) adds such items and services to covered physician services; (2) provides payment at 100 percent of the lesser of the actual charge or a Secretary-determined amount (from the general 80 percent of reasonable charges); (3) waives the Part B deductible (from the general $240 in 2024, adjusted annually); and (4) excludes from noncoverage only those not ordered by a physician or practitioner. (Thus, beneficiaries incur no out-of-pocket costs for such services.) The section also authorizes the Secretary of Health and Human Services to develop quality measures for contraceptive counseling, care, and access. Under Part C (Medicare Advantage), the section includes such items and services within uniform cost-sharing limits not exceeding traditional Part B levels. Under Part D, the section (1) requires Part D plans to cover contraceptive drugs per Public Health Service Act guidelines as protected drugs and (2) waives the deductible and all coinsurance or other cost-sharing for such drugs.

This section directs the Secretary of Health and Human Services to conduct a study on (1) the adequacy of access to prescription drug coverage, including oral contraceptives, among Medicare beneficiaries living with disabilities enrolled in original fee-for-service Medicare under parts A and B of title XVIII of the Social Security Act (but not enrolled under parts C or D); and (2) providing coverage of over-the-counter contraceptive drugs under Medicare with no cost-sharing. (As background, original Medicare under parts A and B does not cover outpatient prescription drugs, which typically requires separate enrollment in Medicare Part D.) The Secretary must submit a report to Congress on the study, together with legislative and administrative recommendations, not later than one year after the date of enactment.

This section directs the Comptroller General of the United States to conduct a study on forms of health insurance, including commercial plans and public health programs (Medicaid, Medicare, and TRICARE), that are not required by state or federal law to cover all FDA-approved forms of contraception or to waive cost-sharing for such contraception. The Comptroller General must submit a report on the study to Congress, together with recommendations for legislation and administrative action, not later than one year after enactment of this Act.

This section directs the Comptroller General of the United States to conduct a study on differences in coverage of contraceptive items and services for dual-eligible individuals (i.e., those eligible for both Medicare and Medicaid benefits). The Comptroller General must submit a report to Congress on the study, including recommendations for legislation and administrative action, within two years of enactment.